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This is VAERS ID 471819

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2012

VAERS ID: 471819
VAERS Form:
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 7/7/2013

VAERS ID: 471819 Before After
VAERS Form:
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 9/14/2017

VAERS ID: 471819 Before After
VAERS Form:(blank) 1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / - UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 2/14/2018

VAERS ID: 471819 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 6/14/2018

VAERS ID: 471819 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 8/14/2018

VAERS ID: 471819 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 9/14/2018

VAERS ID: 471819 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.


Changed on 10/14/2018

VAERS ID: 471819 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:North Carolina
Vaccinated:2012-10-23
Onset:2012-10-24
Submitted:2012-10-26
Entered:2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH732AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Cardiac failure congestive, Condition aggravated, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; Aortic aneurysm; Advanced age
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized 10/16-10/21 with CHF exacerbation and increased weakness. Assessment by HH 10/23/12 and vaccine given. Patient developed nausea later in the day. Called EMS morning of 10/24 and patient taken to E.R.

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